SPECIAL ARTICLE  NON-COVID-19 SECTION Open access

Italian Journal of Emergency Medicine 2021 December;10(3):156-62

DOI: 10.23736/S2532-1285.21.00102-6

Copyright © 2021 THE AUTHORS

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language: English

Improving access to emergency urgency: bed management, patients in-flow and out-flow in a Provincial Hub Hospital

Geminiano R. BANDIERA ¹ ✉, Giampaolo MARINO ²

¹ Department of Emergency, Civil Hospital of Baggiovara, Modena University Hospital, Modena, Italy; ² Department of Health Management, Civil Hospital of Baggiovara, Modena University Hospital, Modena, Italy

On 8^th of July 2019, Emilia-Romagna’s Regional Council enacted “Delibera 1129 - Improvement Plan for access to Emergency Care,” with the purpose of setting correct and effective guidelines to improve access to the Emergency and Urgency services. The final goal is to design, plan and organize the access to the Emergency and Urgency services to optimize the patients’ flow, from the first point of contact with the hospital until final discharge. This plan limits the time patients remain in the Emergency Department (so called “Tempo di Permanenza”) to 6 hours, maximum 7 hours for the most complex cases. The need to reduce the time spent by patient in the Emergency Room has made it necessary to define some process standards, such as “waiting time for first evaluation”, “waiting time for key consultations and/or diagnostics” and “boarding time.” Improvement actions are essential and necessary but, sometimes, difficult to implement in the absence of a specific change in the organizational culture, objectives, and values, on which the management activities of the hospitalized patient are based. Once it is understood that the hospital bed management can no longer be approached in the manner typical of a hotel structure (in the sense of assigning the first bed that becomes free), the concept of “patient flow” must be made its own, which leads to considering the patient as the protagonist of the bed management processes, as a “person” and not only as a pathology. This new approach to Bed Management will involve acquiring new “bed management“ skills and sensitivity on the part of all hospital personnel and all Operating Units (diffuse management).

KEY WORDS: Emergency service, hospital; Triage; Patient discharge